Abstract
Aims
Currently, the decision to initiate extracorporeal life support for patients who suffer
cardiac arrest due to accidental hypothermia is essentially based on serum potassium
level. Our goal was to build a prediction score in order to determine the probability
of survival following rewarming of hypothermic arrested patients based on several
covariates available at admission.
Methods
We included consecutive hypothermic arrested patients who underwent rewarming with
extracorporeal life support. The sample comprised 237 patients identified through
the literature from 18 studies, and 49 additional patients obtained from hospital
data collection. We considered nine potential predictors of survival: age; sex; core
temperature; serum potassium level; mechanism of hypothermia; cardiac rhythm at admission;
witnessed cardiac arrest, rewarming method and cardiopulmonary resuscitation duration
prior to the initiation of extracorporeal life support. The primary outcome parameter
was survival to hospital discharge.
Results
Overall, 106 of the 286 included patients survived (37%; 95% CI: 32–43%), most (84%)
with a good neurological outcome. The final score included the following variables:
age, sex, core temperature at admission, serum potassium level, mechanism of cooling,
and cardiopulmonary resuscitation duration. The corresponding area under the receiver
operating characteristic curve was 0.895 (95% CI: 0.859–0.931) compared to 0.774 (95%
CI: 0.720–0.828) when based on serum potassium level alone.
Conclusions
In this large retrospective study we found that our score was superior to dichotomous
triage based on serum potassium level in assessing which hypothermic patients in cardiac
arrest would benefit from extracorporeal life support. External validation of our
findings is required.
Keywords
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Article info
Publication history
Published online: February 23, 2018
Accepted:
February 20,
2018
Received in revised form:
February 15,
2018
Received:
December 15,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.02.026.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
